Registration

Name *	Mr. Ms.
Title(s) and affiliation(s)
Office Practice or Institution Name *
Office or Institution Address *	Nr. *
Postal code/City *
Country
Business Phone
Fax
Home Address (if preferred)	Nr.
Postal code/City
Country
Home Phone
E-mail*
Yes I would like to attend the meeting on October 20 - 21 2008, in Amsterdam I am a non-sponsored delegate: I will stay from October 20 - 21, including stay in the hotel à € 390,- I will stay from October 20 - 21, excluding stay in the hotel à € 180,- I will only attend the meeting on October 20 à € 100,- I will only attend the meeting on October 21 à € 100,- I am a sponsored delegate: I will stay from October 19 - 21 I will stay from October 20 - 21 Please indicate the name of the company sponsoring your participation
Payment details Please provide us with correct payment information. For Dutch delegates it is possible to pay via Automatisch Incasso. It is also possible to pay with your Mastercard or Visacard. Pay with Mastercard or Visacard (you will be contacted for your credit card details) Payment using Automatisch Incasso for Dutch delegates Please provide us with your bank account information: Account holder name / Account number
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